Lateral elbow pain; finding the pain driver? A need for dualistic reasoning! Lateral elbow pain and movement dysfunction has been subject to a great amount of studies with a wide variability of produced results (5,9). A vast number of local structures and local biomechanics have been accused of being the potential peripheral, structural, driver of symptoms, either through ultrasonographic differentiation...

Screening tests, more questions than answers? A whole series of different screening proposals are being used in musculoskeletal medicine for all sorts of different reasons. The offer goes from red flag screening to sports related pre-participation screening. Many of the screening tests are though not universally accepted and conflicting evidence is frequently found in literature (2). Below I’ve listed up some...

Palpation…passive movement exploration...Can you feel it? Palpation findings are being used by most health care professionals in search for anatomical landmarks, to evaluate and interpret a great variety of properties thought to be linked to tissues like skin, muscles and fascia, nerves, viscera, blood vessels, physiological and accessory joint movements looking for signs of tissue restrictions, and for symptom provocation. I...

Thanks to the IMTA research foundation, who support our work on two-point discrimination in the upper cervical spine, we are now in the middle of the data collection for this exciting research!
The idea for this project was based on the quite robust evidence, that two-point discrimination as a marker for tactile acuity and potentially indicating the extent of cortical...

Before you starting reading this blog, it has to be mentioned that it is restricted to the biomechanics of peripheral nerves. I hope it will give you some interesting thoughts for education and clinical work Education of the evaluation of the peripheral nervous system in musculoskeletal pain and disorders is a major part of IMTA courses-During the last decade other...

This Blog was written together by Jukka Kangas and Wouter Geerse. INDIVIDUAL RESPONSE to patho-anatomical changes and movement dysfunctions Physiotherapists are aware that structural changes in musculoskeletal system don’t correlate directly with pain or functional capacity. In scientific world it is widely accepted that people respond individually to patho-anatomical changes (O’Sullivan 2005, Kangas 2011) and they adopt very different...

In one of our recent courses we had an interesting observation during inspection. (see picture in the title) A marked atrophy of the pectoralis major muscle and absence of the nipple was found. The participant told that he had the “Poland syndrome”. For more information, feel free to look it up in Wikipedia. In his case it mainly affects the sternal portion, which tested...

Most physiotherapists will tell you that there are a number of clinical syndromes that they particularly like or dislike, for whatever reason. What is your favourite group of patients suffering from a musculoskeletal disorder that you like treating, and do you know why? Early on in my career I happened to stumble over a range of patients with stiff shoulders,...

Tendinopathies are problematic to manage clinically. People of different ages with tendons under diverse loads present with varying degrees of pain, irritability, and capacity to function. Recovery is similarly variable; some tendons recover with simple interventions, some remain resistant to all treatments. (Cook&Purdam 2009)
The classic description of the tensile load-bearing region of tendon includes 3 main components (Scott et...

Currently there is a lot of discussion about "Education" as a treatment option in the physiotherapy profession. There is evidence, that education seems to be more effective than other treatment options (Anneleen et al 2017, Babatunde et al 2017, Dolphens et al 2014, Louw et al 2017, Malfliet et al 2017). BUT What does "Education" mean at all?
Is this really...

A critical look at Structural differentiation. Rolf Walter, private practioner CH-6834 Morbio Inferiore The wish for structural differentiation is integral part of medical professions worldwide. Finding the anatomical structure driving the potential painful source of peripheral input may seem logical in situations where a distinct peripheral pain source is expected but observational and community based bias, false positives tests and mal interpretation...

WHAT IS MANUAL THERAPY? IS IT ALL ABOUT OUR HANDS? 3 more mins to read......
Social media
Last weeks I've read on social media some strange statements about manual therapy. Like "passive therapy is old fashioned", "it helps only the teachers & organisations", "it doesn't fit for chronic pain patients" or "it's all about beliefs and far from evidence based medicine /...

Physiotherapist as a scholar
Since the physiotherapy world adopted the roles described in the CanMEDs Competency Framework, physiotherapists officially have a status as life-long learner, labelled with the term ‘scholar’. Long before this was defined, it was clear, that physiotherapists seem to belong to a species which never stops looking for new knowledge and skills. Compared to other health care professionals,...

“Neck or Biceps ? Who`s gonna be the pain driver ?”
Short Case Description over two days of a Lithuanian professional Tuba player Last week we (Sandra and Jürg) had an interesting patient in the student patient session group during the Level1 Maitland course in Kaunas/ Lithuania.
I give you a short description and some clinical reasoning thoughts about these two treatment...